In "Confessions of a Health Care Rationer," Dr. Eric Chevlen explains how health care rationing works in the real world. If you are the least bit interested in the subject [and who can avoid being so these days], his description of the alternatives will be helpful. Read it all here. I find convincing his argument for explicit rather than implicit rationing [rationing in some form, he argues, is inevitable].
.... All modern societies ration health care. A wise society considers the options and chooses a method of doing so which best conforms to its values and capabilities. Thus we come to the terrible question we would so very much like to avoid: How shall we ration health care? How shall we explicitly ration it? So noxious a question is this, so offensive in its tacit assumptions and implications, that most politicians and wishful thinkers will deny that we need to address it at all. They will argue that the fundamental problem is one of distribution, not one of unmeetable demand. They will argue, with more enthusiasm than evidence, that an emphasis on preventive care would substantially reduce aggregate demand. Some will say we must reduce the role of government; others will argue that we should augment it. If only we will adopt their plan—they’ll say—waste, fraud, and abuse will be abolished. There will be chicken—or at least chicken soup—in every pot, and a vaccine in every arm. People love honesty, but they hate the truth. To frankly acknowledge and address the ineluctable reality of healthcare rationing is not merely to touch the proverbial third rail of American politics; it is to lie across the tracks in front of the onrushing train. ....Confessions of a Health Care Rationer | First Things
While the application of any standard of explicit rationing must be equitable, at heart the criteria themselves cannot escape some element of arbitrariness. Whether the criteria are age of the patient, life expectancy with or without treatment, cost of the treatment, rigor of evidence, or simply public clamor—rationing everywhere and always means that someone is denied health care which he believes is necessary for his wellbeing and to which he feels entitled.
Imperfect as it is, using the criterion of medical necessity based on medical evidence is likely the most just and practical way of performing the unavoidable and unpleasant task of rationing health care. Implicit rationing is dishonest and procrustean, bluntly mismatching resources and needs. Rationing by age or life expectancy inevitably leads to decision making based on invidious, not to say immoral, comparisons of individual worth. Rationing primarily by cost obviates the fundamental purpose of having health insurance. Rationing by public clamor introduces the injustice of preferential treatment for those with the greatest political clout. The optimist will consider healthcare rationing based on evidence-based medical necessity as the best of all possible ways of doing it; the pessimist will fear that he’s right.
As Congress and the people consider restructuring the American healthcare system, they must keep in mind that rationing health care may not be undeniable, but it is unavoidable. To claim that Congress will devise a new federal healthcare plan that will not involve rationing is like claiming that it will invent a triangle that doesn’t have three sides. Currently, within the private sector of health care, we have a large number of private insurance companies vying for the business of their customers. They ration health care on the basis of evidence-based medical necessity. The Obama health plan, the details of which are still being worked out, will also ration health care. The alternative to that is an accelerated escalation of aggregate healthcare costs. But the single-payer system to which Obama’s plan will lead will have no competitor and no pressing financial incentive to please its customers. No competitor for the single payer means no alternative for the patient. We can reasonably expect that a single-payer system of rationing will be largely implicit rather than explicit, and governed as much by cost and political considerations as by medical evidence. .... [more]